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According to The Columbus Dispatch, more than half of the 1,141 patients who sought inpatient psychiatric services last month in Franklin County, Ohio, were enrolled in Medicaid and waited, on average, 26 hours for care - twice as long as the typical 13-hour wait for patients who had private health insurance. Most of the county's private psychiatric beds remain largely off-limits to Medicaid enrollees, and the beds that are off-limits to Medicaid patients are typically at free-standing, mostly for-profit psychiatric hospitals. Under federal law, such hospitals that have at least 16 beds, defined as "institutions for mental disease," (IMD) cannot care for Medicaid enrollees who are 21 to 64 years old. Ohio Medicaid has no estimates of how much additional Medicaid spending might occur statewide if the IMD exclusion is lifted. The federal rule dates back half a century and stems from concern that states might try to shift the cost of their psychiatric hospitals to Medicaid programs.